Best Practice Guidelines for Surgical Site Infection in High-risk Pediatric Spine Surgery: Definition, Prevention, Diagnosis, and Treatment

Abstract

Background: Prior "best practice guidelines" (BPG) have identified strategies to reduce the risk of acute deep surgical site infection (SSI), but there still exists large variability in practice. Further, there is still no consensus on which patients are "high risk" for SSI and how SSI should be diagnosed or treated in pediatric spine surgery. We sought to develop an updated, consensus-based BPG informed by available literature and expert opinion on defining high-SSI risk in pediatric spine surgery and on prevention, diagnosis, and treatment of SSI in this high-risk population. Materials and Methods: After a systematic review of the literature, an expert panel of 21 pediatric spine surgeons was selected from the Harms Study Group based on extensive experience in the field of pediatric spine surgery. Using the Delphi process and iterative survey rounds, the expert panel was surveyed for current practices, presented with the systematic review, given the opportunity to voice opinions through a live discussion session and asked to vote regarding preferences privately. Two survey rounds were conducted electronically, after which a live conference was held to present and discuss results. A final electronic survey was then conducted for final voting. Agreement ≥ 70% was considered consensus. Items near consensus were revised if feasible to achieve consensus in subsequent surveys. Results: Consensus was reached for 17 items for defining high-SSI risk, 17 items for preventing, 6 for diagnosing, and 9 for treating SSI in this high-risk population. After final voting, all 21 experts agreed to the publication and implementation of these items in their practice. Conclusions: We present a set of updated consensus-based BPGs for defining high-risk and preventing, diagnosing, and treating SSI in high-risk pediatric spine surgery. We believe that this BPG can limit variability in practice and decrease the incidence of SSI in pediatric spine surgery. Level of Evidence: Not applicable.

Updating the Evidence: Systematic Literature Review of Risk Factors and Strategies for Prevention, Diagnosis, and Treatment of Surgical Site Infection After Pediatric Scoliosis Surgery

“…In a separate article, this evidence subsequently serves as the basis of a Delphi process-driven discussion to generate a Best Practice Guideline. 12…”

“…The evidence extracted in this review subsequently served as the basis of an updated Best Practice Guideline (BPG) developed through expert consensus by a panel of 21 pediatric spine surgeons. 12 Here, we synthesize the findings of our literature search and present graded evidence based on the available data.…”

“…The aim of this study was to systematically review current literature on risk factors for SSI in pediatric patients undergoing scoliosis surgery, as well as strategies for prevention, diagnosis, and treatment. The evidence extracted in this review subsequently served as the basis of an updated Best Practice Guideline (BPG) developed through expert consensus by a panel of 21 pediatric spine surgeons 12 . Here, we synthesize the findings of our literature search and present graded evidence based on the available data.…”

Consensus-Based Best Practice Guidelines for the Management of Spinal Deformity and Associated Tumors in Pediatric Neurofibromatosis Type 1: Screening and Surveillance, Surgical Intervention, and Medical Therapy

“…The method utilized in this study is considered “modified” because the process began with a set of selected items. Consensus was defined as a ≥70% agreement between respondents, a validated parameter utilized in previous Delphi-based studies 23 . The present study was conducted between April 2021 and December 2022.…”

“…Consensus was defined as a ≥ 70% agreement between respondents, a validated parameter utilized in previous Delphi-based studies. 23 The present study was conducted between April 2021 and December 2022.…”